{OVERALL_HEADER}<table width="780" border="0" align="center" cellpadding="0" cellspacing="0">
  <tr class="normal">
    <td valign="top"><br>
      <form name="form1" method="post" action="">
        <span class="header1">Withdraw Money</span><br>
        <br>
MoneyBookers Address:
<input name="address" type="text" id="address" size="40">
<br>
<input type="hidden" name="payment_id" id="payment_id" value="{PAYMENT_ID}">
<input type="hidden" name="amount" id="amount" value="{AMOUNT}">

<br>
<br>
<input name="Submit" type="submit" id="Submit" value="Withdraw">
            </form>
      <br>    </td>
  </tr>
</table>
{OVERALL_FOOTER}